Long-term safety and efficacy of rotational atherectomy for lesion preparation of calcified coronary lesions

Coronary artery calcification (CAC) is frequent in patients undergoing percutaneous coronary intervention (PCI) and debulking-techniques including rotational atherectomy (RA) are frequently used for enhanced lesion preparation prior to stent implantation. To date, long-term clinical outcomes of patients with CAC undergoing RA are scant. This study evaluates the long-term efficacy and safety of RA for lesion preparation of calcified coronary lesions at 3 years. Consecutive patients undergoing RA at the German heart center Munich were included in this registry. Clinical endpoints were the incidence of death, myocardial infarction (MI), target lesion revascularization (TLR) and probable or definite stent thrombosis (ST) at 30 days, 1 year and 3 years. 632 patients with 964 lesions undergoing RA were included in this analysis. The mean age was 74.8 ± 8.6 years and 36.2 % were diabetic. 98.9 % of lesions had severe or moderate calcification and 16.5 % were chronic total occlusion lesions. The cumulative incidence of clinical endpoints at 30 days was: 3.6 % death, 1.3 % MI, 0.8 % TLR and 2.2 % definite or probable ST. The incidence for mid- to long-term outcomes at 1 and 3 years were: 10.2 % and 21.7 % death, 1.4 % and 1.6 % MI, 10.8 % and 13.0 % TLR; 2.5 % and 2.7 % definite or probable ST. In this large retrospective analysis of patients undergoing RA for lesion preparation in calcified lesions rates of thrombotic events are high, mostly occur within the first 30 days. Long-term mortality and revascularization rates remain considerable, likely reflecting the high-risk lesion and patient characteristics of this cohort.